My oncology practice deals with 100% adult patients.
Cancer is by and large a disease that occurs because of ageing, and possibly one out of five patients I see daily is above 65 years old.
Just a fortnight ago, an elderly patient in his 70s came to the clinic for his follow up.
It has been nearly three years since he went under the knife, followed by six weeks of intensive, radical chemoradiotherapy for glioblastoma multiforme, an aggressive type of brain tumour.
Besides the brain tumour, he also has two types of skin cancers that have been effectively treated in the past.
His recent brain magnetic resonance imaging (MRI) was good and he has kept himself active after completing his treatment, running his business and exercising regularly.
That day, he sat himself in the chair swiftly after we exchanged greetings.
I commented that every time I saw him, he was looking better and better.
Twenty years ago, few people his age would have attempted aggressive therapy such as his because they would be seen as too fragile for treatment.
He said to me “Doc, I was getting into the car to come here to meet you and suddenly I noticed I was limping on one leg.
“I thought, hey wait a minute, I have been good all this while. I don’t limp, I am fine!”
He laughed after saying this and proceeded with a conclusion that sets him apart from other cancer patients.
“It’s all in our mind, doc, all in our mind. So, I told myself, the moment I walk into your clinic later, I will feel safe. Here I am and don’t worry Dr Mastura, I managed to snap out of it.”
He just pinned it!
All on his own.
It is amazing that no matter how difficult the situation is, some cancer patients are able to remain focused on living with purpose, and not merely “living with cancer”.
Of special mention would be the older patients who choose not to focus on statistics and just survive almost effortlessly, setting their minds to be positive, despite the realities of the diagnosis, especially when it’s an aggressive form of cancer or a stage four disease.
That is something I love about oncology – the opportunity to observe and learn about courage from our patients is endless.
Now, where do I begin?
Back in 2014 when I was an oncology lecturer at Universiti Malaya, I got to know these two elderly ladies who were both doting grandmothers when they were diagnosed with advanced stage cancers.
In the trunk of my memories, Almarhum Tunku Mukminah Tuanku Mohamad Jiwa or fondly known as Makengku, was literally on oxygen in the intensive care unit when the advanced breast cancer was first detected.
Two weeks later she sat in my clinic, clad in a pretty green blouse and decked with shiny jewellery; she flashed a friendly smile to me, the oncologist who was about half her age then.
Allahyarham Ramlah Abas, who I called Makcik Ramlah, was diagnosed with a rare cancer of the blood vessels in her left upper leg, necessitating an amputation at the hip joint.
The cancer also metastasised to her lungs.
This spunky elderly lady would regularly fly up and down from Kuala Terengganu to the hospital to see her “team of doctors”, namely me, along with her orthopaedic oncologist and plastic surgeon.
At one time, Makengku had a fall at home resulting in a hip fracture.
Despite surgery she could not walk well and often had to use a wheelchair to move around.
Did that stop the both of them from doing their daily routine, travelling, attending events or going around doing charity work?
In fact, Makengku continued pursuing her favourite activities with the Girl Guides and helping orphanages, even appearing in the media to speak on a new cancer drug with me.
I remember how the journalists gathered around her to listen to her honest take of living life to the fullest, right till the end.
Makcik Ramlah had a limb prosthesis after her amputation.
Nonetheless she found much zest jamming on her sewing machine or driving her Myvi around Kuala Terengganu town with just one leg and a stick!
In fact, during the 2018 Malaysian general election, the same year she died, she was still actively campaigning for her party while being wheelchair bound!
I must admit that although we provide patients with cancer treatment, a key aspect to successful therapy is emotional support and kindness towards cancer patients that help diffuse negative emotion and improve their quality of life and cancer outcomes.
Unsurprisingly, these elderly ladies had strong family support.
There was never a time that they were alone on this journey.
Most times they were accompanied by their respective daughters.
Despite her busy schedule, Makengku’s daughter Datuk Sharifah Sofianny ( Sherry) was either physically present or in phone communication with me on her mother’s progress and needs.
Similarly, Makcik Ramlah’s daughter Sheila, who was working abroad, began to fly home almost fortnightly to provide moral and financial support for her mum.
Thereafter, Sheila decided to leave her fulfilling career to settle down in Malaysia for good so she could spend more time with her mother and family.
These patients of mine were housewives who raised kind and strong daughters.
I am happy that we have become good friends since.
Makcik Ramlah survived four years and 10 months before succumbing to advanced leiomyosarcoma on December 17, 2018.
After nearly five years with advanced breast cancer, Makengku passed away on August 24, 2019.
Despite advanced stage cancers, their positivity had allowed them to live a few more good years with love and style. They were always warm, never without a smile.
They found joy in family. They enjoyed deeper meaning in “just living” in kindness.
They never saw cancer as a hindrance or a sickness. They just learned to live with it.
This is my tribute to these two inspiring ladies I respected very much and whose positive attributes I will never forget.
May their souls rest in peace.
Dr Mastura Md Yusof is a consultant oncologist.